Nobody knows exactly how many people rushed to help after the attack on the World Trade Center five years ago. The working estimate is 40,000, and it includes not only New York firefighters, police officers, ironworkers and neighborhood volunteers but also communications workers from Chicago and rescuers from California. They came from across the country to work on "the pile," as the smoldering ruins were known, or at Fresh Kills on Staten Island, where what remained of the twin towers was eventually moved for closer examination.

Now, many of these generous people, people who had no trouble passing a physical on Sept. 10, are paying with their health. Because they failed to wear or sometimes even obtain the proper breathing masks, and because they were misled by assurances that the toxic fumes were not dangerous, many are now sick or even dying. It is time for all those politicians who are waving the flag this month over Sept. 11 to start providing care for the living victims of that day.

The evidence of problems for these workers has grown steadily since 2001. The latest survey by the Mount Sinai Medical Center in New York City estimates that nearly 7 of 10 people who responded after Sept. 11 have suffered new or worsening lung problems. The center's survey of about 9,500 people found that those who responded earliest were now the ones suffering the worst.

Recent initiatives from Mayor Michael Bloomberg and state leaders are welcome, even five years late. It would be easy to criticize them for being slow in recognizing the need, but the real failure has been in Washington. This is a national problem, requiring federal answers.

The terrorists attacked the United States, not New York. Understanding that, people came from across America to help. Their medical costs and compensation for long-term disabilities must be handled through a national plan that treats everyone, from illegal immigrant cleaners to firefighters to physicians, with equal respect.

Yet until recently, Congress and the Bush administration have barely managed to squeeze out enough money for surveys to determine the extent of illnesses related to ground zero. A scant $52 million has been set aside for medical care, but so far, none of that money has reached a real patient. Even Dr. John Howard, who was appointed in February as the administration's coordinator for 9/11 health efforts, recognized the frustration. He said of those waiting for medical help, "I can't blame them for thinking, 'Where were you when we needed you?'"

They still need help. Congress and the White House need to make sure there is enough money to continue monitoring those from around the country who were caught in the toxic dust. And they need to make money available quickly for responders who grow sicker with each Sept. 11.

A version of this article appears in print on September 6, 2006, in The International Herald Tribune. Today's Paper|Subscribe